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The effect of 1 month of therapy with midodrine, octreotide‐LAR and albumin in refractory ascites: a pilot study
Author(s) -
Tandon Puneeta,
Tsuyuki Ross T.,
Mitchell Lesley,
Hoskinson Michael,
Ma Mang M.,
Wong Winnie W.,
Mason Andrew L.,
Gutfreund Klaus,
Bain Vincent G.
Publication year - 2009
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2008.01778.x
Subject(s) - medicine , midodrine , ascites , octreotide , renal function , gastroenterology , paracentesis , hepatorenal syndrome , urology , portal hypertension , portal venous pressure , plasma renin activity , liver disease , endocrinology , cirrhosis , blood pressure , renin–angiotensin system , somatostatin , orthostatic vital signs
Background: The pathogenesis of refractory ascites (RA) is linked to splanchnic vasodilation. We hypothesized that a combination of midodrine, octreotide long‐acting release (LAR) and albumin would result in increased natriuresis, better control of ascites and an improvement in renal function in patients with RA±Type 2 hepatorenal syndrome. Methods: A prospective pilot study in patients with RA as defined by the International Ascites Club. Consecutive patients received an intramuscular injection of octreotide‐LAR, 50 g of albumin three times per week and midodrine titrated to increase the systolic blood pressure for 1 month. Results: Ten patients with RA were enrolled and eight with complete data to 1 month post‐treatment were included in the analysis. There was no change in renal function but there was a trend towards a reduction in the volume of ascites removed by paracentesis ( P =0.08) and a significant reduction in the plasma renin ( P =0.01) and aldosterone concentrations ( P =0.01). Interestingly, there was a transient worsening in the model for end‐stage liver disease (MELD) score ( P =0.01). The deterioration in MELD was completely reversible after discontinuation of therapy. Conclusions: To our knowledge, this is the first study of prolonged midodrine, octreotide and albumin therapy in RA. We observed a significant reduction in the plasma renin and aldosterone concentrations and a trend towards a reduction in the volume of ascites removed by paracentesis without an effect on renal function. The beneficial effects are at the expense of a reversible deterioration in the MELD score. Large controlled trials are needed before this therapy can be routinely recommended.